11/01/2005
Dear Editor:
In response to Matthew Simmons’ article, “Fuel Fossils” (August 2005), the author states that transportation accounts for 70 percent of oil use and that increased oil costs will force corporations to reorder supply chains to minimize shipping costs. For thousands of years, human empires developed robust intercontinental trade fueled by wind-powered ships and horses. Humans have always overcome adversity, and an oil shock will only bring out the best in revolutionaries such as Paul Allen and Burt Rutan, who built the first privately funded and owned spacecraft.
Dwindling supplies of expensive oil will not end international commerce.
Aircraft can be made more efficient. Automobiles, trucks and trains can use
alternative fuels such as hydrogen, vegetable oil and natural gas. France
acquires over 50 percent of its energy from nuclear power, Germany obtains
significant energy from solar power, the United States and China have enormous
coal reserves and dams. Progress requires exploiting these alternate resources.
As oil prices rise, alternate energy, which may be expensive today, will become
more competitive. In the future, as ever-increasing demand for diminishing natural resources accelerates, humans will have to seek new mineral, water and energy resources off our planet.
There are two possible futures for civilization. The first is a nightmare scenario in which humans keep depleting the Earth’s resources. As world population rises toward 10 billion, we begin a cycle of continuous war over decreasing resources to feed an unsustainable population. Eventually, war, starvation and disease would overwhelm the human race.
In the second future, humans would venture beyond Earth to access the limitless raw materials of outer space, which would easily accommodate any number of humans and allow wealthy countries to continue consumer-driven economies unabated while avoiding resource wars. A serious space exploitation program is the only way that humans can sustain unlimited consumption economies.
Our greatest conquests, such as Columbus or America’s western expansion, were about securing more resources. In the 21st century there is little unexploited land left on Earth, so space is the logical place for growth. Our solar system has enough resources to outlast humanity, so an oil shock should not threaten us.
As long as we have visionaries such as Allen, Rutan and Richard Branson, the future of international trade will be secure.
William Hubbell MiamiSubstance over Style
Dear Editor:
I am writing in response to the feature article entitled “Concierge Medicine” (July 2005). While we applaud Dr. Howard Maron’s ingenuity and innovation, it was his elitist practice model (MD2) that led to the media-generated nomenclature (concierge, boutique) that inappropriately stereotyped all dialects of the original concept. Furthermore, we successfully developed what was thought to be the first non-transitioned, retainer-based practice in the United States, avoiding any perception of patient abandonment. As such, it is reasonable to consider a more accurate, and less biased, global reference to this method of health care delivery: Membership Medical Practices (MMP).
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If research in the future validates recent pilot data, then care quality in MMPs
might objectively justify their existence. Similarly, while there are definite
levels of intellectual and practical capabilities that must be maintained by all
physicians, it is unfair to make claims that physicians within these settings
have diminished skill or knowledge. There is no evidence that physicians
practicing in low-volume settings have less favorable success with specialty
board testing or are responsible for more medical errors. In fact, it may be
argued that practicing within a more manageable environment allows physicians to
more efficiently utilize their knowledge and skill, rather than often serving as
a triage depot constrained by the demands of volume. It is also inaccurate to
assume that these physicians care for only healthy individuals, since a large
number of medically complex persons migrate to these practices because of
previously unmet health care needs. While being subjected to more patients may
increase exposure to pathology, it may restrict a practitioner’s ability to
intimately follow and actively participate in many aspects of a patient’s care
or perform procedures due to time constraints. Importantly, it is primarily the
health care system that is responsible for the deficiencies in care and service,
not the physicians trapped within its domain.
We agree that the actual impact of this concept is limited and grossly
overemphasized (currently estimated at less than 1 percent of all practicing
primary care physicians in this country!). In fact, the Government
Accountability Office has recently determined that this concept is not a threat
to the legitimacy of Medicare or the health care system. Any “controversy” is
merely perceived and based only on fallacies and unjustified assumptions.
Discussion and debate are natural components of health care evolution, but this
should not be a distraction to reality.Patients have the right to choose their method of receiving health care, and physician businessmen have the right to choose their method of delivering health care. As long as legal and ethical prerequisites are not ignored, MMPs could complement a pluralistic health care system.
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Michael O’Neal, DO
CooperativeMed
Tampa, Fla.
Only Themselves to Blame
Dear Editor:
The comments made by John Harrison in “From the Mouths of Babes” (September 2005, page 128) regarding teenagers and intolerance were really annoying. First he denigrates people who work hard in school and life by implying that these are not the primary factors in individual success. Then he states that the economic “deck of life” is stacked against those without the proper skin color, social connections or access to the tools of wealth creation.
Mr. Harrison need only look at the long-term studies of wealth creation in immigrant families to understand that individual initiative and sacrifice can and do overcome all the factors he mentions. Long hours of study, the discipline to save and a tireless work ethic will forever count for more than the “limousine liberal” concepts of social justice and sustainability championed by his organization (Resource Generation).
Charlie Smith Pittsburgh